Affiliate Application

Please complete the following form to apply for CCPR affiliation.

Name
*

Department
*

E-mail
*

Request Type
*

Faculty Affiliate Student Affiliate Non-Resident Affiliate Postdoc

Non-Resident Information

* Non-resident affiliates must be in collaboration with a current CCPR faculty affiliate. Faculty affilates must sponsor a non-resident affiliate's membership into CCPR. Sponsorship will be verified prior to affiliation approval.

Postdoc Information

* Postdocs must be in collaboration with a current CCPR faculty affiliate. Faculty affiliates must sponsor a postdoc's membership into CCPR. Sponsorship will be verified prior to affiliation approval.

Current Status
*

non-UCLA Faculty non-UCLA Student Other option

Current Institution
*

Purpose
*

Please provide a short explanation of why you would like to be affiliated with CCPR.

CCPR Faculty Collaborator
*

Collaborator E-mail
*

How long do you expect your collaboration to last?
*

Advisor and Funding

* Student affiliates must be sponsored by a current CCPR faculty affiliate. This sponsor must be the student's primary advisor or a member of their graduate committee or the student must work for the sponsor. Sponsorship will be verified prior to affiliation approval.